《2005AASLD：急性肝衰竭指南》内容预览

All patients with clinical or laboratory evidence of moderate to severe acute hepatitis should have immediate measurement of prothrombin time and careful evaluation for subtle alterations in mentation. If the prothrombin time is prolonged by 4-6 seconds or more (INR 1.5) and there is any evidence of altered sensorium, the diag-nosis of ALF is established and hospital admission is man- datory. Since the condition may progress rapidly, with changes in consciousness occurring hour-by-hour, early transfer to the intensive care unit (ICU) is preferred once the diagnosis of ALF is made.

History taking should include careful review of possi- ble exposures to viral infection and drugs or other toxins.  If severe encephalopathy is present, the history may be provided entirely by the family or may be unavailable. In this setting, limited information is available, particularly regarding possible toxin/drug ingestions. Physical exami- nation must include careful assessment and documenta- tion of mental status and a search for stigmata of chronic liver disease. Jaundice is often but not always seen at pre-sentation. Right upper quadrant tenderness is variably present. Inability to palpate the liver or even to percuss a significant area of dullness over the liver can be indicative of decreased liver volume due to massive hepatocyte loss. An enlarged liver may be seen early in viral hepatitis or with malignant infiltration, congestive heart failure, or acute Budd-Chiari syndrome. History or signs of cirrhosis should be absent as such features suggest underlying chronic liver disease, which may have different manage- ment implications. Furthermore, the prognostic criteria mentioned below are not applicable to patients with acute-on-chronic liver disease.

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